Friday, December 21, 2007

Gays spread AIDS, Malay kids are dumb 2

Once again, the title is deliberately provocative.The release of the PSLE results has prompted discussions on the correlation between the students' race and their performance.One blogger, featured on The Singapore Daily, views the news that the top student this year is a Malay child thus:"I’m not much of a statistics person, but I do detect something interesting. Looking at the past PSLE trends, it would statistically be more likely to find Chinese top students than Malay or Indian ones. However, as you can see, in 2005, 2006 and 2007, statistics & probability take a back seat as non-Chinese students score top marks.

2007 is particularly intriguing for me. Of the listed top 16 students, all were Chinese except for Natasha (which works fine statistically, I suppose). But for Natasha to be the top-scorer ahead of her Chinese peers is a statistic anomaly (but possible). Not only that, Natasha was not only the top student in 2007 (apparently by being a few marks clear of the other top students), she is also the highest scoring PSLE student EVER, for Chinese, Indian, Malay or students from any other ethnic group. This is statistically improbable (but possible, let me just say that)."Mr Wang has his own theory about why "the minority races (Malays and Indians) seem to be statistically overrepresented among the very top PSLE performers", and in his comments section he wrote:"I'm just talking about probabilities.... If the majority of GEP students were Chinese, probability tells that the top GEP student is likely to be Chinese. None of the above is sexist or or racist, but simply mathematical. The actual outcome, however, went against probability for three straight years in a row, and so the question is whether this is just a statistical quirk, or whether there is some other factor like what I, or the other blogger, or some readers here, have mentioned."There is, in reality, no statistical quirk.The statistics only appear as an anomaly to us because the way that the data was presented to us has led us to see a pattern where there was none to begin with.The fact is that that years of being presented with the PSLE results categorised by the students' race have led us to think that the students' performance are somehow a function of their race.But what does all this have to do with gays and AIDS?Well, for that, you'll have to read Part 1 of this post.

THE admission form looks the same — with the addition of a clause that could be crucial in the fight against Aids: "I do not want to be screened for HIV".

From yesterday, all adult in-patients at Changi General Hospital (CGH) had to sign against that statement if they did not want to be tested for HIV.

But even as Singapore's pilot voluntary, opt-out HIV-testing scheme takes off, it seems more must be done to shift society's attitudes on managing the disease.

Most of the visitors at CGH whom Today spoke to were unaware of the scheme to increase HIV-testing rates. Of the eight polled who thought it was "a good idea", five would not consent to testing because they "did not fall into the high-risk groups" — the kind of reaction HIV-prevention advocates are trying to change.

The process at CGH is simple enough: Conventionally, all patients being admitted sign a General Consent for Admission Form, which now has the added clause.

A CGH spokesperson said: "The consulting doctor will inform the patient of the HIV screening, provide him or her HIV Testing brochures to read, and answer any questions."

If patients, or an authorised person, decline the test, they sign next to the opt-out option. Otherwise, depending on their ward class, they will pay between $6 and $23 for the test.

According to CGH, it is still too early to disclose the take-up rate. But according to visitors like Mr Ong, 56: "It's not for me … It's good for single, young men only. Elder and married men like me who have only one partner are more decent and safe."

Mr C K Koh, 54, said: "Testing isn't for me — the more you know, the more problems there will be."

But Action for Aids (AfA) executive director Lionel Lee stressed that HIV is everybody's problem and hopes the testing agenda will take root. "Once testing becomes a normal thing, like any test for a chronic disease, it will be more accepted by the population."

Other hospitals, such as Singapore General Hospital and K K Women's and Children's Hospital will roll out voluntary, opt-out HIV testing for inpatients in the next few months, in line with HIV prevention guidelines from the American Centres for Disease Control.

AfA's anonymous testing programme had just 500 tests done when it started in 1997. It was 6,046 last year, and Mr Lee expects a 10-to-20-per-cent rise on that by the end of the year.

Yes, of course everyone should have a HIV test, but *I* don't need one. People like me don't get AIDS; only people like *them* do.Well, if people who think they can't be HIV-positive will not opt to be tested, and those who think they may be HIV-positive won't either, then angry doc really wonders if a "voluntary, opt-out" scheme will really make a difference in the grand scheme of things. In any case, such a scheme will only cover those who are admitted to a hospital, and not pick up asymptomatic 'carriers', who presumably make up the majority of HIV-positive patients.Given that anonymous HIV testing had been available for about ten years, accessibility and cost to testing are probably not a major obstacle in the fight against HIV/AIDS. Until the reason behind people's reluctance to testing are identified and addressed, angry doc doubts voluntary opportunistic screening of a small segment of the population (less than 10% of the resident population if all hospitals implement such a scheme) will reduce the incidence of new HIV infections.

Thursday, December 13, 2007

A tangled web

ON MONDAY, Changi General Hospital (CGH) will become the first hospital here to offer opt-out HIV testing for inpatients 21 years and above. Patients can decline to be tested.

They can indicate their preference in a general consent form for medical treatment, given to them on admission. Those who agree to the blood test will pay between $6 and $23, depending on the ward class.

The result will be ready after three hours, and will be kept strictly confidential.

"If the HIV test is positive, we will provide the patient with care and treatment at the hospital and refer them for appropriate follow-up after discharge," said the hospital's CEO, Mr T K Udairam.

Treatment for conditions such as diarrhoea and pneumonia will differ for HIV patients because the causes are different.

Patients with HIV can also be put on antiretroviral drugs — which can prolong life and improve its quality — without unnecessary delay.

The results of the HIV test will be revealed to only the patient, the doctors, and — if it is positive — the Health Ministry, which the hospital is required to notify by law.

It will not be released to third parties such as employers or insurers.

Other hospitals are also considering voluntary opt-out HIV testing for inpatients.

The Singapore General Hospital says it will introduce the testing for all inpatients early next year, while KK Women's and Children's Hospital will do so next month for the few adult male patients warded there, according to 938Live.

A spokesperson for the National Healthcare Group, which comprises Tan Tock Seng, Alexandra Hospital and National University Hospital, said there are no plans for opt-out HIV testing at this juncture.

The move to test patients come amid rising number of cases. Up until October this year, a total of 356 new HIV cases were reported, just one fewer than the number for the whole of last year.

The idea for opt-out HIV testing was first mooted by Health Minister Khaw Boon Wan in August.

I thank Mr Lim for providing feedback on his experience at our clinic on Nov 24. I had spoken to him on the same day to ensure that he was fine.

The management has also contacted him to inform him of the actions taken and to offer apologies for his experience at the clinic.

We have reviewed our processes to prevent a recurrence. Our physicians and staff have also been reminded to be sensitive in their communications with our clients.

Mr Lim's feedback has enabled a new establishment like Bao Zhong Tang to resolve its teething problems and improve services.

Gina Lee (Ms) Clinic Manager Bao Zhong Tang TCM Centre

Given that TCM and acupuncture are ancient healing arts purportedly hundreds or even thousands of years old, angry doc assumes that the 'teething problems' Ms Lee refers to are not clinical in nature, which begs the question of what problems exactly she meant when she used that phrase.Did she mean the problems with continuity of care in a team-based care setting, problems with communication, or problems with having to deal with complaints being directed through a public forum?